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Hidalgo NJ, Pando E, Mata R, Fernandes N, Villasante S, Barros M, Herms D, Blanco L, Balsells J, Charco R. Impact of comorbidities on hospital mortality in patients with acute pancreatitis: a population-based study of 110,021 patients. BMC Gastroenterol 2023; 23:81. [PMID: 36949385 PMCID: PMC10035222 DOI: 10.1186/s12876-023-02730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. METHODS We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. RESULTS A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p < 0.001), heart disease (OR: 1.73, p < 0.001), renal disease (OR: 1.99, p < 0.001), moderate-severe liver disease (OR: 2.86, p < 0.001), peripheral vascular disease (OR: 1.43, p < 0.001), and cerebrovascular disease (OR: 1.63, p < 0.001) were independent risk factors for mortality. The Charlson > 1.5 (OR: 2.03, p < 0.001) and Elixhauser > 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality. CONCLUSIONS Advanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Elizabeth Pando
- Universitat Autonoma de Barcelona, Barcelona, Spain.
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain.
| | - Rodrigo Mata
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Nair Fernandes
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Sara Villasante
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Marta Barros
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Daniel Herms
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Laia Blanco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Joaquim Balsells
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Ramon Charco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
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Chen Z, Wang Y, Zhang H, Yin H, Hu C, Huang Z, Tan Q, Song B, Deng L, Xia Q. Deep Learning Models for Severity Prediction of Acute Pancreatitis in the Early Phase From Abdominal Nonenhanced Computed Tomography Images. Pancreas 2023; 52:e45-e53. [PMID: 37378899 DOI: 10.1097/mpa.0000000000002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To develop and validate deep learning (DL) models for predicting the severity of acute pancreatitis (AP) by using abdominal nonenhanced computed tomography (CT) images. METHODS The study included 978 AP patients admitted within 72 hours after onset and performed abdominal CT on admission. The image DL model was built by the convolutional neural networks. The combined model was developed by integrating CT images and clinical markers. The performance of the models was evaluated by using the area under the receiver operating characteristic curve. RESULTS The clinical, Image DL, and the combined DL models were developed in 783 AP patients and validated in 195 AP patients. The combined models possessed the predictive accuracy of 90.0%, 32.4%, and 74.2% for mild, moderately severe, and severe AP. The combined DL model outperformed clinical and image DL models with 0.820 (95% confidence interval, 0.759-0.871), the sensitivity of 84.76% and the specificity of 66.67% for predicting mild AP and the area under the receiver operating characteristic curve of 0.920 (95% confidence interval, 0.873-0.954), the sensitivity of 90.32%, and the specificity of 82.93% for predicting severe AP. CONCLUSIONS The DL technology allows nonenhanced CT images as a novel tool for predicting the severity of AP.
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Affiliation(s)
- Zhiyao Chen
- From the Pancreatitis Center, Center of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huiling Zhang
- Infervision Medical Technology Co., Ltd, Beijing, China
| | - Hongkun Yin
- Infervision Medical Technology Co., Ltd, Beijing, China
| | - Cheng Hu
- From the Pancreatitis Center, Center of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyuan Tan
- From the Pancreatitis Center, Center of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | | | - Lihui Deng
- From the Pancreatitis Center, Center of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Xia
- From the Pancreatitis Center, Center of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
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3
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Chan KS, Shelat VG. Diagnosis, severity stratification and management of adult acute pancreatitis–current evidence and controversies. World J Gastrointest Surg 2022; 14:1179-1197. [PMID: 36504520 PMCID: PMC9727576 DOI: 10.4240/wjgs.v14.i11.1179] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/08/2022] [Accepted: 10/25/2022] [Indexed: 02/07/2023] Open
Abstract
Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe with an unpredictable natural course. Majority of cases (80%) are mild and self-limiting. However, severe AP (SAP) has a mortality risk of up to 30%. Establishing aetiology and risk stratification are essential pillars of clinical care. Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause. Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence. In SAP, patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit. Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP. Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition. If unable to tolerate per-orally, nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit. Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis. Delayed step-up strategy including percutaneous retroperitoneal drainage, endoscopic debridement, or minimal-access necrosectomy are sufficient in most SAP patients. Patients should be monitored for diabetes mellitus and pseudocyst.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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4
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Tang J, Chen T, Ni W, Chen X. Dynamic nomogram for persistent organ failure in acute biliary pancreatitis: Development and validation in a retrospective study. Dig Liver Dis 2022; 54:805-811. [PMID: 34305014 DOI: 10.1016/j.dld.2021.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Persistent organ failure (POF) increases the risk of death in patients with acute biliary pancreatitis (ABP). Currently, there is no early risk assessment tool for POF in patients with ABP. AIMS To establish and validate a dynamic nomogram for predicting the risk of POF in ABP. METHODS This was a retrospective study of 792 patients with ABP, with 595 cases in the development group and 197 cases in the validation group. Least absolute shrinkage and selection operator regression screened the predictors of POF, and logistic regression established the model (P < 0.05). A dynamic nomogram showed the model. We evaluated the model's discrimination, calibration, and clinical effectiveness; used the bootstrap method for internal validation; and conducted external validation in the validation group. RESULTS Neutrophils, haematocrit, serum calcium, and blood urea nitrogen were predictors of POF in ABP. In the development group and validation group, the areas under the receiver operating characteristic curves (AUROCs) were 0.875 and 0.854, respectively, and the Hosmer-Lemeshow test (P > 0.05) and calibration curve showed good consistency between the actual and prediction probability. Decision curve analysis showed that the dynamic nomogram has excellent clinical value. CONCLUSION This dynamic nomogram helps with the early identification and screening of high-risk patients with POF in ABP.
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Affiliation(s)
- Jia Tang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Tao Chen
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wei Ni
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xia Chen
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Alberti P, Pando E, Mata R, Cirera A, Fernandes N, Hidalgo N, Gomez-Jurado MJ, Vidal L, Dopazo C, Blanco L, Gómez C, Caralt M, Balsells J, Charco R. The role of procalcitonin as a prognostic factor for acute cholangitis and infections in acute pancreatitis: a prospective cohort study from a European single center. HPB (Oxford) 2022; 24:875-884. [PMID: 34802942 DOI: 10.1016/j.hpb.2021.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infection in acute pancreatitis will worsen the disease prognosis. The aim of our study was to analyze the role of procalcitonin as a prognostic biomarker for infections and clinical severity. METHOD A prospective single-cohort observational study of patients diagnosed of acute pancreatitis (n = 152) was designed. PCT determination was tested on admission (first 72 h). Infections (biliary, extrapancreatic and infected pancreatic necrosis), need for antibiotics, urgent ERCP and severity scores for acute pancreatitis was assessed. ROC curves were designed and the area under the curve was calculated. Logistic regression for multivariate analysis was performed to evaluate the association between procalcitonin optimal cut-off level and major complications. RESULTS PCT >0.68 mg/dL had higher incidence of global infection, acute cholangitis, bacteraemia, infected pancreatic necrosis, use of antibiotics in general, and need for urgent ERCP. In the multivariate regressions analysis, PCT >0.68 mg/dL at admission demonstrated to be a strong risk factor for complications in acute pancreatitis. DISCUSSION PCT levels can be used as a reliable laboratory test to predict infections and the clinical severity of acute pancreatitis. High levels of PCT predict antibiotics prescription as well as the need for urgent ERCP in patients with concomitant clinically severe cholangitis.
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Affiliation(s)
- Piero Alberti
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Elizabeth Pando
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain.
| | - Rodrigo Mata
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Arturo Cirera
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Nair Fernandes
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Nils Hidalgo
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - María J Gomez-Jurado
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Laura Vidal
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Cristina Dopazo
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Laia Blanco
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Concepción Gómez
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Mireia Caralt
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Joaquim Balsells
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Ramón Charco
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
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Jia W, Xu L, Xu W, Yang M, Zhang Y. Application of nanotechnology in the diagnosis and treatment of acute pancreatitis. NANOSCALE ADVANCES 2022; 4:1949-1961. [PMID: 36133408 PMCID: PMC9419146 DOI: 10.1039/d2na00020b] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 06/16/2023]
Abstract
Acute pancreatitis (AP) is a common digestive system disease. The severity of AP ranges from mild edema in the pancreas to severe systemic inflammatory responses leading to peripancreatic/pancreatic necrosis, multi-organ failure and death. Improving the sensitivity of AP diagnosis and developing alternatives to traditional methods to treat AP have gained the attention of researchers. With the continuous rise of nanotechnology, it is being widely used in daily life, biomedicine, chemical energy and many other fields. Studies have demonstrated the effectiveness of nanotechnology in the diagnosis and treatment of AP. Nanotechnology has the advantages of simplicity, rapidity and sensitivity in detecting biomarkers of AP, as well as enhancing imaging, which helps in the early diagnosis of AP. On the other hand, nanoparticles (NPs) have oxidative stress inhibiting and anti-inflammatory effects, and can also be loaded with drugs as well as being used in anti-infection therapy, providing a new approach for the treatment of AP. In this article, we elaborate and summarize on the potential of nanoparticles for diagnostic and therapeutic applications in AP from the current reported literature and experimental results to provide useful guidelines for further research on the application of nanotechnology.
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Affiliation(s)
- WeiLu Jia
- Medical School, Southeast University Nanjing 210009 China
| | - LinFeng Xu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University Nanjing 210009 China
| | - WenJing Xu
- Medical School, Southeast University Nanjing 210009 China
| | - Meng Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing 100730 China
| | - YeWei Zhang
- Medical School, Southeast University Nanjing 210009 China
- Hepatopancreatobiliary Center, The Second Affiliated Hospital of Nanjing Medical University Nanjing 210009 China
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Mohammed HSED, Ramadan HKA, El-Mahdy RI, Ahmed EH, Hosni A, Mokhtar AA. The Prognostic Value of Different Levels of Cortisol and High-sensitivity C-reactive Protein in Early Acute Pancreatitis. Am J Med Sci 2021; 363:435-443. [PMID: 34798139 DOI: 10.1016/j.amjms.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/09/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) ranges in severity from mild to severe with high mortality. Severe AP, similar to other critical illnesses, is associated with changes in cortisol level. Early increase of high-sensitivity C-reactive protein (hs-CRP) as an inflammatory marker could be an indicator of AP progression. We aimed to assess the level of cortisol and hs-CRP on initial diagnosis of AP and identify their prognostic value. METHODS This case-control study included patients with AP and a control group of healthy subjects. Laboratory tests such as liver profile, kidney functions, blood picture, lactate dehydrogenase, blood glucose, and lipogram were evaluated, the severity of AP was determined, the duration of hospitalization, complications, and outcomes were identified, and the serum levels of cortisol and hs-CRP were assessed. RESULTS There were 90 patients with AP and 60 controls with a higher percent of females in both groups. Serum cortisol and hs-CRP were significantly higher in AP relative to controls and were higher in severe AP relative to mild AP. Significant positive correlation was present between high cortisol and severity of AP (r=0.520 and p<0.001) and negatively with pancreatic necrosis (r= - 0.303 and p= 0.007) and morality (r= - 0.432, p= 0.005) while hs-CRP did not show significant correlation. CONCLUSIONS Different levels of serum cortisol in early AP should be considered on initial diagnosis. High cortisol level was a good prognostic indicator for AP with low mortality. This could have further implications on the appropriate initiation of steroid therapy to prevent necrotizing pancreatitis and lower the mortality. Meanwhile, hs-CRP has a low prognostic value in early AP.
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Affiliation(s)
| | - Haidi Karam-Allah Ramadan
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Reham I El-Mahdy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Entsar H Ahmed
- Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt
| | - Amal Hosni
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abeer A Mokhtar
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Bai J, Bai J, Yang M. Interleukin-22 Attenuates Acute Pancreatitis-Associated Intestinal Mucosa Injury in Mice via STAT3 Activation. Gut Liver 2021; 15:771-781. [PMID: 33495423 PMCID: PMC8444107 DOI: 10.5009/gnl20210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 11/04/2022] Open
Abstract
Background/Aims Interleukin-22 (IL-22) is an important cytokine maintaining homeostasis at barrier surfaces. In this study, the role of IL-22 in acute pancreatitis-associated intestinal injury was further explored. Methods Severe acute pancreatitis (SAP) was induced by administration of L-arginine in Balb/c mice at different time gradients. Histopathological examinations were made in both the pancreas and small intestine. Furthermore, recombinant murine IL-22 (rIL-22) was administrated to L-arginine-induced SAP mice by intraperitoneal injection. The mRNA levels of IL-22R1, Reg-IIIβ, Reg-IIIγ, Bcl-2, and Bcl-xL were detected in the small intestine by real-time polymerase chain reaction, and protein levels of total and phosphorylated STAT3 were assessed via Western blot. Results Compared with normal control group, 72 hours of L-arginine exposure induced the most characteristic histopathological changes of SAP, evidenced by pathological changes and serum amylase levels. Meanwhile, significant pancreatitis-associated intestinal mucosa injury was also observed. The gene expression levels of antimicrobial proteins Reg-IIIβ, Reg-IIIγ and anti-apoptosis proteins Bcl-2, Bcl-xL were downregulated in small intestine. Furthermore, Larginine- induced SAP was attenuated by rIL-22 treatment. Importantly, pancreatitis-associated intestinal mucosa injury was also ameliorated, reflected by improved pathological changes and significant increase in gene expression levels of Reg-IIIβ, Reg-IIIγ, Bcl-2 and Bcl-xL. Consistently, serum amylase levels and mortality were decreased in mice treated with rIL-22. Mechanistically, the upregulated expressions of these protective genes were achieved by activating STAT3. Conclusions Exogenous rIL-22 attenuates L-arginine-induced acute pancreatitis and intestinal mucosa injury in mice, via activating STAT3 signaling pathway and enhancing the expression of antimicrobial peptides and antiapoptotic genes.
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Affiliation(s)
- Jinxia Bai
- Department of Emergency and Critical Care Medicine, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Jinyun Bai
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
| | - Meng Yang
- Dayi Primary Education Group, Shanghai, China
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9
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Abstract
Introduction: Acute pancreatitis (AP) is a common gastrointestinal disease with a wide spectrum of severity and morbidity. Developed in 1974, the Ranson score was the first scoring system to prognosticate AP. Over the past decades, while the Ranson score remains widely used, it was identified to have certain limitations, such as having low predictive power. It has also been criticized for its 48-hour requirement for computation of the final score, which has been argued to potentially delay management. With advancements in our understanding of AP, is the Ranson score still relevant as an effective prognostication system for AP?Areas covered: This review summarizes the available evidence comparing Ranson score with other conventional and novel scoring systems, in terms of prognostic accuracy, benefits, limitations and clinical applicability. It also evaluates the effectiveness of Ranson score with regard to the Revised Atlanta Classification.Expert opinion: The Ranson score consistently exhibits comparable prognostic accuracy to other newer scoring systems, and the 48-hour timeframe for computing the full Ranson score is an inherent strength, not a weakness. These aspects, coupled with relative ease of use, practicality and universality of the score, advocate for the continued relevance of the Ranson score in modern clinical practice.
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Affiliation(s)
- Yuki Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vishal G Shelat
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- FRCS (General Surgery), FEBS (HPB Surgery), Hepato-Pancreatico-BiliarySurgery, Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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10
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Rim D, Kaye A, Choi C, Ahlawat S. Inpatient Outcomes of Acute Pancreatitis Among Patients With Systemic Lupus Erythematosus: A Nationwide Analysis. Cureus 2021; 13:e16349. [PMID: 34306896 PMCID: PMC8279928 DOI: 10.7759/cureus.16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives This study explores the characteristics and outcomes, including inpatient mortality, length of stay, and pancreatitis complications in patients hospitalized with acute pancreatitis (AP) with coexisting systemic lupus erythematosus (SLE). Methods Patients hospitalized with AP from the National Inpatient Sample from 2014 were selected. Patient characteristics and outcomes of AP were compared between the groups with and without SLE. Age, sex, race, Elixhauser Comorbidity Index (ECI), and etiologies of pancreatitis were measured. The outcomes of interest were inpatient mortality, length of stay, and complications, including respiratory failure, acute renal failure, myocardial infarction, hypotensive shock, sepsis, stroke, and ileus. Chi-squared tests and independent t-tests were used to compare proportions and means, respectively. Multivariate logistic regression analysis was performed to determine if SLE is an independent predictor for the outcomes, adjusting for age, sex, race, ECI, and etiologies of pancreatitis. Results Among 434,280 AP patients identified in the study, 3,015 patients had SLE. Among patients hospitalized with AP, those with SLE were younger, more likely to be female, more likely to be non-White, had higher ECI, and stayed longer in the hospital. Patients without SLE were more likely to have a history of cholelithiasis, alcohol abuse, and hypertriglyceridemia. AP patients presenting with SLE were at higher risk for respiratory failure, acute renal failure, hypotensive shock, stroke, and sepsis. Higher inpatient mortality was also associated with coexisting SLE. Conclusions Patients admitted for AP with SLE have worse outcomes compared to those without SLE. Understanding the potential effects of SLE on AP and optimizing patient care in this population accordingly may improve the quality of care and outcomes.
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Affiliation(s)
- Daniel Rim
- Internal Medicine, Rutgers University, Newark, USA
| | | | | | - Sushil Ahlawat
- Gastroenterology and Hepatology, Rutgers University, Newark, USA
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11
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A practical means of evaluating the prognosis of acute pancreatitis, as measurement of carotid artery intima-media thickness. Acta Gastroenterol Belg 2021; 84:437-442. [PMID: 34599568 DOI: 10.51821/84.3.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Factors such as age, obesity, diabetes mellitus and hyperlipidemia that cause adverse prognosis in acute pancreatitis also cause an increase in carotid intima-media thickness. In this study, we aimed to investigate the usability of the measurement of carotid intima-media thickness, which is an easy to apply, cost-effective means of measurement applied to the patients, in predicting AP prognosis, apart from the criteria currently utilized to predict AP prognosis. PATIENTS AND METHODS 101 patients diagnosed with acute pancreatitis were prospectively enrolled into the study. Right and left common carotid artery intima-media thickness, right and left internal carotid artery intima-media thickness were measured with ultrasonographic images performed within the first 24 hours of hospitalization. local or systemic complications and organ failure development were monitored in the follow-up of the patients. RESULTS After the ROC analysis was performed and the threshold value was determined. The patients with main and internal carotid artery intima-media thickness above 0.775 mm were seen to have a more severe AP (p = 0.000). Local and systemic complications and organ failure were also more common in these patients. CONCLUSIONS Measurement of carotid intima-media thickness is a non-invasive method that can be used to predict the prognosis in patients with acute pancreatitis at presentation.
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Factors Associated with Fluid Sequestration in Patients with Acute Pancreatitis: A Prospective Study in Tertiary Centre Hospital in Nepal. Gastroenterol Res Pract 2021; 2021:5579267. [PMID: 34257644 PMCID: PMC8253623 DOI: 10.1155/2021/5579267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/03/2021] [Accepted: 06/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acute pancreatitis (AP) is associated with extensive fluid sequestration. The aim of this study was to determine association of fluid sequestration at 48 hours after hospital admission (FS48) in AP patients with demographics, clinical parameters, and outcomes of AP. Methods A prospective observational study was carried out on all adult patients with AP admitted to Tribhuvan University Teaching Hospital, Nepal, from January to September 2017. FS48 was calculated as the difference between fluid input and output in the first 48 hours of admission. The Kruskal-Wallis test with post hoc Dunn's test examined the difference in FS48 between mild AP, moderately severe AP, and severe AP. Linear regression analysis was used to evaluate association between FS48 with patients' characteristics and outcomes of AP. Outcomes of AP assessed included pancreatic necrosis, persistent organ failure, length of stay, and in-hospital mortality. Results Eighty patients (median age 44 years; 57% male) with a median FS48 of 1610 mL were evaluated. The median FS48 for mild AP, moderately severe AP, and severe AP were 1,180 mL, 2,380 mL, and 3,500 mL, respectively. There was a significant difference in pairwise comparisons between mild AP and moderately severe AP, along with mild AP and severe AP. Younger age, other etiology, and higher creatinine were independently associated with increased FS48. Increased FS48 was significantly associated with pancreatic necrosis, persistent organ failure, and in-hospital mortality. Conclusions In our study population, younger age and higher creatinine were predictors of increased FS48. Increased FS48 was associated with poorer outcomes of AP.
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Wu Y, Liao GY, Ke HJ, Liu P. Effects of Snake-Derived Phospholipase A2 Inhibitors on Acute Pancreatitis: In vitro and in vivo Characterization. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:4765-4774. [PMID: 33192052 PMCID: PMC7656965 DOI: 10.2147/dddt.s270443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
Objective We aimed to investigate the effects of snake-derived phospholipase A2 inhibitor (PLA2) from Sinonatrix percarinata and Bungarus multicinctus on acute pancreatitis in vivo and in vitro and assess the mechanisms. Methods The levels of platelet-activating factor (PAF) and tumor necrosis factor (TNF)-α were detected by ELISA, and the characteristics of autophagy were detected by transmission electron microscopy and Western blotting (LC3, p62, and ATG5). Results In vitro experiments showed that PLA2 treatment caused obvious formation of autophagic bodies. By contrast, Sinonatrix and Bungarus peptides reduced the number of autophagic bodies. The concentrations of PAF and TNF-α, and the expressions of p62, autophagy-related 5 (ATG5), and microtubule-associated protein 1A/1B-light chain 3 (LC3)II/LC3I in the PLA2-treated group were significantly higher than in the control group (P<0.05). The concentrations of PAF and TNF-α, and the expressions of p62, ATG5, and LC3II/LC3I in the Sinonatrix or Bungarus peptide treatment groups were significantly lower than in the PLA2-treated cells (P<0.05). In the pancreatic tissue, autophagic bodies were observed in the model group; autophagic bodies were remarkably reduced in Sinonatrix or Bungarus peptide-treated groups compared with the model group. In vivo experiments also showed that the levels of PAF and TNF-α, and the expressions of p62, ATG5, and LC3II/LC3I were significantly higher in the model group than in the control group (P<0.05). The levels of PAF and TNF-α in the model group, and the expressions of p62, ATG5, and LC3II/LC3I in Sinonatrix or Bungarus peptide-treated groups were significantly lower than in the model group (P<0.05). Conclusion Sinonatrix or Bungarus peptide could ameliorate the features of acute pancreatitis, likely through regulating autophagy.
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Affiliation(s)
- Yanping Wu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, People's Republic of China
| | - Gen-You Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, People's Republic of China
| | - Hua-Jing Ke
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, People's Republic of China
| | - Pi Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, People's Republic of China
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14
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Early laboratory biomarkers for severity in acute pancreatitis; A systematic review and meta-analysis. Pancreatology 2020; 20:1302-1311. [PMID: 32938552 DOI: 10.1016/j.pan.2020.09.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/25/2020] [Accepted: 09/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Acute pancreatitis is complicated by local and systemic complications in 20-30% of the patients. Accurate prediction of severity may be important for clinical decision making. Our aim is to identify and compare the accuracy of laboratory biomarkers that predict severity and complications in adult patients. METHODS Medline, EMBASE, Web of Science and Cochrane Library (1993 to August 2020) were searched for studies with an unselected population of patients with acute pancreatitis, that contains accuracy data for ≥1 laboratory biomarker(s) and/or APACHE-II score for the prediction of a patient outcomes of interest during the first 48 h of admission. The primary outcome is moderate severe or severe acute pancreatitis (MSAP/SAP). Secondary outcomes are severe acute pancreatitis, pancreatic necrosis and organ failure. Risk of bias was assed using QUADAS-2. Biomarkers extracted from ≥3 unique sources, were analyzed using hierarchical summary receiver operating characteristic (HSROC) and bivariate model analysis. RESULTS In total, 181 studies were included in the qualitative analysis reporting on 29 biomarkers. For the primary outcome at admission, summary sensitivities and specificities were, respectively, 87% (95% CI 69-95%) and 88% (95% CI 80-93%) for IL-6 at a threshold of >50 pg/ml, 72% (95% CI 64-79%) and 76% (95% CI 67-84%) for an APACHE-II score of ≥8, and 53% (95% CI 35-71%) and 82% (95% CI 74-88%) for CRP >150 mg/l. HSROC curve analysis confirmed these results. CONCLUSION This study indicates superiority of IL-6 for the early prediction of MSAP/SAP and may be used for to guide clinical decision making.
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15
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Xue BH, Liu Y, Chen H, Sun Y, Yu WL. A novel function of IRF9 in acute pancreatitis by modulating cell apoptosis, proliferation, migration, and suppressing SIRT1-p53. Mol Cell Biochem 2020; 472:125-134. [PMID: 32577948 DOI: 10.1007/s11010-020-03791-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/13/2020] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis (AP) is an inflammatory disease caused by the abnormal activation of pancreatic enzymes in the pancreas, with a considerably high morbidity and mortality. However, the etiological factor and pathogenesis of AP are still unclear. This study was aimed to explore the role and mechanism of interferon regulatory factor 9 (IRF9) in the occurrence of AP and to provide experimental and theoretical foundation for AP diagnosis and treatment. AP model in vitro was established by caerulein-induced group. Small interfering RNA (siRNA) was designed and constructed to silence IRF9 gene. After siRNA transfected and caerulein treated successfully, the expression levels of IRF9, SIRT1, and acetylated p53 (Ac-p53) were determined by qRT-PCR and Western blot. The apoptosis, proliferation, and migration of AR42J cells were checked by flow cytometry, MTT, and transwell assay. Dual-luciferase reporter assay was implemented to validate the regulatory effect of IRF9 on SIRT1. Here, our study showed that the expression of IRF9 and Ac-p53 was increased, SIRT1 was decreased, and cell apoptosis, proliferation, and migration of AR42J cells were increased after caerulein induced. IRF9 gene silencing upregulated SIRT1, downregulated Ac-p53, and inhibited cell apoptosis, proliferation, and migration. Dual-Luciferase reporter assay showed that IRF9 could negatively regulate SIRT1. The potential mechanism was that IRF9 could modulate cell apoptosis, proliferation, migration, and bind the promoter of SIRT1 to repress SIRT1-p53. It hinted that IRF9 showed a novel function in AP by modulating cell apoptosis, proliferation, migration, and suppressing SIRT1-p53. IRF9 might be a good potential treatment target for AP.
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Affiliation(s)
- Bin-Hua Xue
- Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Yi Liu
- Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Hu Chen
- Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Yun Sun
- Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Wei-Li Yu
- Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China.
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16
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Cuéllar-Monterrubio JE, Monreal-Robles R, González-Moreno EI, Borjas-Almaguer OD, Herrera-Elizondo JL, García-Compean D, Maldonado-Garza HJ, González-González JA. Nonaggressive Versus Aggressive Intravenous Fluid Therapy in Acute Pancreatitis With More Than 24 Hours From Disease Onset: A Randomized Controlled Trial. Pancreas 2020; 49:579-583. [PMID: 32282773 DOI: 10.1097/mpa.0000000000001528] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to compare a "nonaggressive" hydration versus an "aggressive" hydration using Hartmann's solution in patients with acute pancreatitis (AP) with more than 24 hours from disease onset. METHODS We included 88 patients with AP with more than 24 hours from disease onset, and were randomized into 2 groups. Group I (n = 45) received a nonaggressive hydration (Hartmann's solution at 1.5 mL kg h for the first 24 hours and 30 mL kg during the next 24 hours), and group II (n = 43) received an aggressive hydration (bolus of Hartmann's solution 20 mL kg, followed by an infusion of 3 mL kg h for the first 24 hours and then 30 mL kg for the next 24 hours). RESULTS The mean volume of fluid administered was greater in group II (P < 0.001). We did not find differences when comparing both groups in reference to persistent systemic inflammatory response syndrome (P = 0.528), pancreatic necrosis (P = 0.710), respiratory complications (P = 0.999), acute kidney injury (P = 0.714), or length of hospital stay (P = 0.892). CONCLUSIONS Our study suggests that the clinical evolution of patients with AP with more than 24 hours from disease onset is similar using an aggressive or nonaggressive hydration.
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Affiliation(s)
- Jesús Eduardo Cuéllar-Monterrubio
- From the Servicio de Gastroenterología, Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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17
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Ding L, Yang Y, Li H, Wang H, Gao P. Circulating Lymphocyte Subsets Induce Secondary Infection in Acute Pancreatitis. Front Cell Infect Microbiol 2020; 10:128. [PMID: 32296650 PMCID: PMC7136471 DOI: 10.3389/fcimb.2020.00128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
Acute pancreatitis (AP) is considered a cascade of immune responses triggered by acinar cell necrosis. AP involves two main processes of systemic inflammatory response syndrome and subsequent compensatory anti-inflammatory response syndrome. Although great efforts have been made regarding AP therapy, the mortality rate of AP remains high. Secondary infection acts a lethal factor in AP. Lymphocytes act as major immune mediators in immune responses in the course of this disease. However, the relationship between lymphocytes and secondary infection in AP is unclear. This review summarizes the variation of lymphocytes and infection in AP. Knowledge of the characterization of circulating lymphocyte abnormalities is relevant for understanding the pathophysiology of AP.
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Affiliation(s)
- Lili Ding
- Department of Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Yimin Yang
- Department of Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Hongxiang Li
- Department of Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Haijiao Wang
- Department of Gynecology Oncology, The First Hospital of Jilin University, Changchun, China
| | - Pujun Gao
- Department of Hepatology, The First Hospital of Jilin University, Jilin University, Changchun, China
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18
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Walsh CG, Chaudhry B, Dua P, Goodman KW, Kaplan B, Kavuluru R, Solomonides A, Subbian V. Stigma, biomarkers, and algorithmic bias: recommendations for precision behavioral health with artificial intelligence. JAMIA Open 2020; 3:9-15. [PMID: 32607482 PMCID: PMC7309258 DOI: 10.1093/jamiaopen/ooz054] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/29/2019] [Accepted: 10/30/2019] [Indexed: 12/22/2022] Open
Abstract
Effective implementation of artificial intelligence in behavioral healthcare delivery depends on overcoming challenges that are pronounced in this domain. Self and social stigma contribute to under-reported symptoms, and under-coding worsens ascertainment. Health disparities contribute to algorithmic bias. Lack of reliable biological and clinical markers hinders model development, and model explainability challenges impede trust among users. In this perspective, we describe these challenges and discuss design and implementation recommendations to overcome them in intelligent systems for behavioral and mental health.
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Affiliation(s)
- Colin G Walsh
- Biomedical Informatics, Medicine and Psychiatry, Vanderbilt University Medical Center, 2525 West End, Suite 1475, Nashville, TN, USA
| | - Beenish Chaudhry
- School of Computing and Informatics, University of Louisiana at Lafayette, Lafayette, Louisiana, USA
| | - Prerna Dua
- Department of Health Informatics and Information Management, Louisiana Tech University, Ruston, Louisiana, USA
| | - Kenneth W Goodman
- Institute for Bioethics and Health Policy, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Bonnie Kaplan
- Yale Center for Medical Informatics, Yale Bioethics Center, Yale Information Society, Yale Solomon Center for Health Law & Policy, Yale University, New Haven, Connecticut, USA
| | - Ramakanth Kavuluru
- Division of Biomedical Informatics, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Anthony Solomonides
- Outcomes Research and Biomedical Informatics, NorthShore University HealthSystem, Research Institute, Evanston, Illinois, USA
| | - Vignesh Subbian
- Department of Biomedical Engineering, Department of Systems and Industrial Engineering, The University of Arizona, Tucson, Arizona, USA
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19
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Huang C, Chen S, Zhang T, Li D, Huang Z, Huang J, Qin Y, Chen B, Cheng G, Ma F, Zhou M. TLR3 Ligand PolyI:C Prevents Acute Pancreatitis Through the Interferon-β/Interferon-α/β Receptor Signaling Pathway in a Caerulein-Induced Pancreatitis Mouse Model. Front Immunol 2019; 10:980. [PMID: 31130960 PMCID: PMC6509240 DOI: 10.3389/fimmu.2019.00980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/16/2019] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis (AP) is a common and devastating inflammatory disorder of the pancreas. However, there are still no effective treatments available for the disease. Therefore, it is important to discover new therapeutic targets and strategies for better treatment and prognosis of AP patients. Toll-like receptor 3 (TLR3) ligand polyI:C is a double-stranded RNA mimic that can be used as an immune stimulant. Our current study indicates that polyI:C exerted excellent anti-inflammatory effects in a caerulein-induced AP mouse model and taurocholate-induced pancreatic acinar cell line injury model. We found that polyI:C triggers type I interferon (IFN) production and downstream IFN-α/β receptor (IFNAR)-dependent signaling, which play key roles in protecting the pancreas from inflammatory injury. Knockout of IFN-β and IFNAR in mice abolished the preventive effects of polyI:C on caerulein-induced AP symptoms, which include pancreatic edema, neutrophil infiltration, the accumulation of reactive oxygen species (ROS), and inflammatory gene expression. Treating pancreatic acinar 266-6 cells with an IFNAR inhibitor, which blocks the interaction between type I IFN and IFNAR, diminishes the downregulation of oxidative stress by polyI:C. Additionally, a subsequent transcriptome analysis on the role of polyI:C in treating pancreatitis suggested that chemotaxis of neutrophils and the production of ROS were inhibited by polyI:C in the pancreases damaged by caerulein injection. Thus, polyI:C may act as a type I IFN inducer to alleviate AP, and it has the potential to be a promising therapeutic agent used at the early stages of AP.
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Affiliation(s)
- Chaohao Huang
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Department of Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Suzhou Institute of Systems Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Suzhou, China.,Center for Systems Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengchuan Chen
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Department of Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Suzhou Institute of Systems Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Suzhou, China.,Center for Systems Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tan Zhang
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Department of Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Suzhou Institute of Systems Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Suzhou, China.,Center for Systems Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dapei Li
- Suzhou Institute of Systems Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Suzhou, China.,Center for Systems Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhonglin Huang
- Suzhou Institute of Systems Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Suzhou, China.,Center for Systems Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian Huang
- Department of Emergency, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanghua Qin
- Department of Laboratory Diagnosis, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Bicheng Chen
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Department of Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Genhong Cheng
- Suzhou Institute of Systems Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Suzhou, China.,Center for Systems Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Ma
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Department of Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Suzhou Institute of Systems Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Suzhou, China.,Center for Systems Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Mengtao Zhou
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Department of Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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20
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Żorniak M, Beyer G, Mayerle J. Risk Stratification and Early Conservative Treatment of Acute Pancreatitis. Visc Med 2019; 35:82-89. [PMID: 31192241 PMCID: PMC6514505 DOI: 10.1159/000497290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/28/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a potentially life-threatening common gastrointestinal disorder with increasing incidence around the globe. Although the majority of cases will take an uneventful, mild course, a fraction of patients is at risk of moderately severe or severe pancreatitis which is burdened with substantial morbidity and mortality. Early identification of patients at risk of a severe disease course and an adopted treatment strategy are crucial to avoid adverse outcomes. SUMMARY In this review we summarize the most recent concepts of severity grading in patients diagnosed with AP by adopting recommendations of current guidelines and discussing them in the context of the available literature. The severity of AP depends on the presence of local and/or systemic complications and organ failure. To predict the severity early in the disease course, host-specific factors (age, comorbidities, body mass index), clinical risk factors (biochemical and physiological parameters and scoring systems), as well as the response to initial therapy need to be considered and revisited in the short term. Depending on the individual risk and comorbidity the initial treatment can be guided, which will be discussed in the second part of this review. KEY MESSAGE Predicting the severity of AP and adapting the individual treatment strategy requires multidimensional risk assessment and close observation during the early phase of AP development.
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Affiliation(s)
- Michał Żorniak
- Department of Gastroenterology, Medical University of Silesia, Katowice, Poland
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
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21
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Kim TY, Kim SJ, Kim YS, Lee JW, Park EJ, Lee SJ, Lee KJ, Cha YS. Delta neutrophil index as an early predictive marker of severe acute pancreatitis in the emergency department. United European Gastroenterol J 2019; 7:488-495. [PMID: 31065366 DOI: 10.1177/2050640619838359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 02/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background Predicting severe acute pancreatitis (AP) in the early clinical stage is important for low morbidity and mortality. Delta neutrophil index (DNI) is used to detect infection and inflammation, but no previous studies have evaluated the usefulness of DNI as an early predictor of progression to severe AP (SAP). Methods The medical records of patients who were diagnosed with AP at the emergency department (ED) of Wonju Severance Christian Hospital from January 2012 to August 2016 were retrospectively reviewed. The initial DNI obtained in the ED was compared with other inflammatory markers to predict SAP. Multivariate logistic regression was used for statistical analysis. Results Of the 209 cases included in the analysis, 13 were classified as SAP. Compared to the DNI of the mild to moderately SAP group, that in the SAP group was considerably higher. The DNI showed a positive correlation with the Atlanta classification and bedside index of severity in AP. Using multivariate logistic regression analysis, DNI was an independent predictor of early SAP detection (odds ratio 1.122, 95% CI 1.045-1.205, p = 0.001). Among the biomarkers, DNI had the highest predictive value for SAP. Conclusions The DNI measured in the ED at presentation is a potentially useful adjunctive marker to predict SAP.
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Affiliation(s)
- Tae Y Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sun J Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yoon S Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jong W Lee
- Department of Laboratory Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Eung J Park
- Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seok J Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kyong J Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong S Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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22
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Huang L, Chen C, Yang L, Wan R, Hu G. Neutrophil-to-lymphocyte ratio can specifically predict the severity of hypertriglyceridemia-induced acute pancreatitis compared with white blood cell. J Clin Lab Anal 2019; 33:e22839. [PMID: 30737845 PMCID: PMC6528595 DOI: 10.1002/jcla.22839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/30/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives We aimed to evaluate the values of neutrophil‐to‐lymphocyte ratio (NLR) and white blood cell (WBC) in predicting severity of acute pancreatitis (AP) with different etiologies. Methods We compared NLR and WBC levels in patients with different etiologies and AP severity. The optimal cutoff value for them to predict severe acute pancreatitis (SAP) was determined by receiver operating characteristic (ROC) curve analysis. Results Both NLR and WBC were elevated in patients with SAP. After subgrouping AP by etiology, NLR was predictive of SAP only in hypertriglyceridemia‐induced AP (HTG‐AP), while WBC could effectively predict severity in both gallstone and HTG‐AP. The best cutoff value of WBC for predicting SAP in gallstone AP patients was 12.81 × 109/L, with sensitivity and specificity of 78.9% and 70.2%. The best cutoff value for NLR and WBC to differentiate HTG‐SAP was more than 5.88 and 15.89 × 109/L, respectively, with sensitivity and specificity of 87% and 50% for NLR and 56.5% and 75.76% for WBC. Conclusions Our study firstly demonstrated that NLR selectively played a role in HTG‐AP, while WBC could predict the severity of both gallstone and HTG‐AP. Furthermore, we firstly elucidated that NLR was more sensitive and accurate in judging the severity of HTG‐AP compared with WBC.
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Affiliation(s)
- Li Huang
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Congying Chen
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijuan Yang
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Wan
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoyong Hu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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23
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Joshy G, Banks E, Lowe A, Wolfe R, Tickle L, Armstrong B, Clements M. Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123 697 Australian men. BMJ Open 2018; 8:e022613. [PMID: 30552254 PMCID: PMC6303562 DOI: 10.1136/bmjopen-2018-022613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To develop and validate a prediction model for short-term mortality in Australian men aged ≥45years, using age and self-reported health variables, for use when implementing the Australian Clinical Practice Guidelines for Prostate-Specific Antigen (PSA) Testing and Early Management of Test-Detected Prostate Cancer. Implementation of one of the Guideline recommendations requires an estimate of 7-year mortality. DESIGN Prospective cohort study using questionnaire data linked to mortality data. SETTING Men aged ≥45years randomly sampled from the general population of New South Wales, Australia, participating in the 45 and Up Study. PARTICIPANTS 123 697 men who completed the baseline postal questionnaire (distributed from 1 January 2006 to 31 December 2008) and gave informed consent for follow-up through linkage of their data to population health databases. PRIMARY OUTCOME MEASURES The primary outcome was all-cause mortality. RESULTS 12 160 died during follow-up (median=5.9 years). Following age-adjustment, self-reported health was the strongest predictor of all-cause mortality (C-index: 0.827; 95% CI 0.824 to 0.831). Three prediction models for all-cause mortality were validated, with predictors: Model-1: age group and self-rated health; Model-2: variables common to the 45 and Up Study and the Australian Health Survey and subselected using stepwise regression and Model-3: all variables selected using stepwise regression. Final predictions calibrated well with observed all-cause mortality rates. The 90th percentile for the 7-year mortality risks ranged from 1.92% to 83.94% for ages 45-85 years. CONCLUSIONS We developed prediction scores for short-term mortality using age and self-reported health measures and validated the scores against national mortality rates. Along with age, simple measures such as self-rated health, which can be easily obtained without physical examination, were strong predictors of all-cause mortality in the 45 and Up Study. Seven-year mortality risk estimates from Model-3 suggest that the impact of the mortality risk prediction tool on men's decision making would be small in the recommended age (50-69 years) for PSA testing, but it may discourage testing at older ages.
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Affiliation(s)
- Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Sax Institute, Haymarket, New South Wales, Australia
| | - Anthony Lowe
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Leonie Tickle
- Department of Applied Finance and Actuarial Studies, Macquarie University, Sydney, New South Wales, Australia
| | - Bruce Armstrong
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Mark Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Avanesov M, Löser A, Smagarynska A, Keller S, Guerreiro H, Tahir E, Karul M, Adam G, Yamamura J. Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry. PLoS One 2018; 13:e0206062. [PMID: 30359398 PMCID: PMC6201910 DOI: 10.1371/journal.pone.0206062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/06/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The necrosis-fibrosis hypothesis describes a continuum between single attacks of acute pancreatitis (SAP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) with endocrine and exocrine pancreatic insufficiency. For prevention purposes we evaluated clinico-radiological parameters and pancreatic volumetry to compare SAP and RAP and provide prognostic relevance on short-term mortality, need for intervention and the hospitalization duration. MATERIALS AND METHODS We retrospectively investigated 225 consecutive patients (150 males, range 19-97years) with acute pancreatitis (74%SAP, 26%RAP) according to the revised Atlanta classification. All patients received an intravenous contrast-enhanced CT after a median time of 5 (IQR 5-7) days after onset of symptoms. Two experienced observers rated the severity of AP by 3 CT scores (CTSI, mCTSI, EPIC). Moreover, total pancreatic volumes and additional parenchymal necrosis volumes were assessed, when appropriate. Clinical parameters were etiology of AP, lipase on admission, CRP 48 hours after admission (CRP48), and the presence of organ dysfunction, assessed by the modified Marshall score. The modified Marshall score included systolic blood pressure, serum creatinine, and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio) and was assessed on admission and 48 hours after admission to find patients with persistent organ failure. Outcome parameters were total hospitalization duration, short-term mortality and need for intervention. RESULTS Lipase, CRP48, etiology of AP, EPIC, PaO2/FiO2 ratio, and the presence of a pleural effusion differed significantly in both groups (p<0.05). In 109 patients with interstitial edematous AP, the total pancreatic volume was significantly smaller in patients with RAP compared to those with SAP (69±35cm3; (RAP) vs 106±45cm3; (SAP), p<0.001). All outcome parameters including the mortality rates (SAP vs. RAP: 15% vs. 7%) were comparable in both groups (p>0.05). In the necrotizing RAP group, only the necrotic volume correlated significantly with total hospitalization time (r = 0.72, p<0.001), whereas the systolic blood pressure was the only, but weak predictor for short-term mortality (β-coefficient: -0.05, p = 0.03) and the need for intervention (β-coefficient: -0.02, p = 0.048) in the total RAP group. In patients with SAP, the modified Marshall score was the strongest predictor of short-term mortality, followed by the mCTSI on multivariate logistic regression (Marshall score: β-coefficient: 1.79, p<0.001; mCTSI: β-coefficient: 0.40, p<0.001). CTSI was the best predictor for required intervention in necrotizing SAP (β-coefficient: 0.46, p<0.001), followed by the volume of intrapancreatic necrosis (β-coefficient: 0.17, p = 0.03). CONCLUSION Total pancreatic volume differed significantly between interstitial RAP and SAP and intrapancreatic necrosis volume revealed prognostic value for the total hospitalization duration in necrotizing RAP. Although all outcome parameters were comparable between SAP and RAP, only systolic blood pressure and pancreatic volumetry were prognostic in RAP. In SAP, only the modified Marshall score and mCTSI revealed prognostic value for short-term mortality, whereas CTSI was predictive for the need for intervention.
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Affiliation(s)
- Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anastassia Löser
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alla Smagarynska
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Murat Karul
- Department of Diagnostic and Interventional Radiology, Marienkrankenhaus, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lei JJ, Zhou L, Xiong C, Liu Q, Deng WH. Clinical utility of fibrin-related biomarkers in human acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2018; 26:1176-1185. [DOI: 10.11569/wcjd.v26.i19.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether the four fibrin-related markers (FRMs) fibrin monomer (FM), D-dimer (D-D), fibrinogen (FIB), and fibrin degradation products (FDP) reflect the extent of coagulation activation in vivo and to assess the predictive value of the FRMs in determining persistent organ failure (POF) and pancreatic necrosis (PN) in acute pancreatitis (AP) patients.
METHODS One hundred and fifty-two AP patients were included in this prospective observational study. The final outcome was disease severity assessed by presence of POF and PN. The levels of the four FRMs were measured on days 1, 2, 3, and 7 after admission. ROC curves were used to compare the sensitivity, specificity, PPV, and NPV of FM, D-D, and FDP in predicting POF and PN with those of regular biochemical markers C-reaction protein (CRP) and lactate dehydrogenase (LDH).
RESULTS Of the 152 patients included, 32 had POF and 44 had PN. There was no significant difference in serum FM levels between AP with POF and AP without POF at the first week after admission. Patients with PN had significantly higher FM than those without PN on day 1 (P = 0.043), day 2 (P = 0.008), day 3 (P = 0.001), and day 7 (P = 0.002) after admission. D-D was significantly higher in patients with POF than in those without on day 1 (P = 0.001), day 2 (P = 0.004), day 3 (P = 0.000), and day 7 (P = 0.002). Patients with PN had significantly higher D-D on day 1 (P = 0.023), day 2 (P = 0.045), day 3 (P = 0.000), and day 7 (P = 0.000) after admission. FDP was significantly higher in patients with POF than in those without on day 1 (P = 0.000), day 2 (P = 0.000), day 3 (P = 0.000), and day 7 (P = 0.000). Patients with PN had signficantly higher FDP on day 2 (P = 0.021), day 3 (P = 0.000), and day 7 (P = 0.000) after admission. FIB did not differ significantly between AP patients with POF and those without, or between AP patients with PN and those without. ROC analysis revealed that D-D (AUC = 0.693) and FDP (AUC = 0.711) were superior to CRP (AUC = 0.615) and LDH (AUC = 0.672) in predicting POF on day 1 of hospital admission, and D-D (AUC = 0.832) and FDP (AUC = 0.814) were superior than LDH (AUC = 0.639) and CRP (AUC = 0.706) in predicting PN on day 3 of hospital admission.
CONCLUSION Plasma FRMs in AP patients increase significantly on the first week after admission. FDP and D-D correlate with disease severity of AP and can be considered as a potentially useful tool for the early diagnosis of AP with POF and PN.
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Affiliation(s)
- Jing-Jing Lei
- Department of Gastroenterology, the Affiliated Baiyun Hospital of Guizhou Medical University, Guiyan 550014, Guizhou Province, China
| | - Li Zhou
- Department of Gastroenterology, the Affiliated Baiyun Hospital of Guizhou Medical University, Guiyan 550014, Guizhou Province, China
| | - Can Xiong
- Department of Gastroenterology, the Affiliated Baiyun Hospital of Guizhou Medical University, Guiyan 550014, Guizhou Province, China
| | - Qi Liu
- Department of Gastroenterology, the Affiliated Baiyun Hospital of Guizhou Medical University, Guiyan 550014, Guizhou Province, China
| | - Wan-Hang Deng
- Department of Gastroenterology, the Affiliated Baiyun Hospital of Guizhou Medical University, Guiyan 550014, Guizhou Province, China
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Association between HLA-DR Expression and Multidrug-resistant Infection in Patients with Severe Acute Pancreatitis. Curr Med Sci 2018; 38:449-454. [PMID: 30074211 DOI: 10.1007/s11596-018-1899-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/03/2018] [Indexed: 12/11/2022]
Abstract
Multidrug-resistant (MDR) bacterial infection is a common complication of severe acute pancreatitis (SAP). This study aimed to explore the association between human leukocyte antigen-antigen D-related (HLA-DR) expression and multidrug-resistant infection in patients with SAP. A total of 24 SAP patients who were admitted to Nanjing Drum Tower Hospital between May 2015 and December 2016 were enrolled in the study. The percentages of CD4+, CD8+, natural killer (NK), and HLA-DR (CD14+) cells and the CD4+/CD8+ cell ratio on days 1,7,14, and 28 after admission were determined by flow cytometry. Eighteen patients presented with the symptoms of infection. Among them, 55.6% patients (10/18) developed MDR infection. The most common causative MDR organisms were Enterobacter cloacae and Acinetobacter baumannii. The CD4+/CD8+ cell ratio and the percentage of NK cells were similar between patients with non-MDR and patients with MDR infections. In patients without infection, the HLA-DR percentage was maintained at a high level throughout the 28 days. Compared to the patients without any infection, the HLA-DR percentage in patients with non-MDR infection was reduced on day 1 but increased and reached similar levels on day 28. In patients with MDR infection, the HLA-DR percentage remained below normal levels at all-time points. It was concluded that persistent down-regulation of HLA-DR expression is associated with MDR bacterial infection in patients with SAP.
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27
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Gurusamy KS, Debray TPA, Rompianesi G. Prognostic models for predicting the severity and mortality in people with acute pancreatitis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical School; Department of Surgery; Royal Free Hospital Rowland Hill Street London UK NW3 2PF
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care; Cochrane Netherlands; PO Box 85500 3508 GA Utrecht Utrecht Netherlands
| | - Gianluca Rompianesi
- University of Modena and Reggio Emilia; International Doctorate School in Clinical and Experimental Medicine; Modena Italy
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Liu H, Zhang W, Deng XD, Ma Y, Liu Y. Association of IL-8-251A/T polymorphism with acute pancreatitis susceptibility: A meta-analysis. Shijie Huaren Xiaohua Zazhi 2018; 26:174-181. [DOI: 10.11569/wcjd.v26.i3.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To systematically evaluate the association between the rs4073 (-251A/T) polymorphism in the interleukin-18 (IL-18) gene promoter and susceptibility to acute pancreatitis (AP).
METHODS According to the retrieval strategy, studies about IL-8-251A/T polymorphism and AP were selected from PubMed, EMBASE, Web of Science, CNKI, Wanfang, and VIP electronic databases up to June 2017. We conducted a systematic analysis and meta-analysis to evaluate the association between the polymorphism and AP risk based on the currently available evidence of the literature, including allele genetic model, heterozygous, homozygous, dominant, and recessive genetic models.
RESULTS A total of eight studies involving 1190 cases and 1369 controls were finally included. We found that the T allele of the IL-8-251A/T polymorphism significantly decreased AP risk (OR = 0.770, 95%CI: 0.686-0.865, P < 0.001). The IL-8-251A/T polymorphism was significantly associated with genetic susceptibility to AP under all genetic models (homozygous: OR = 0.543, 95%CI: 0.368-0.799, P < 0.001; heterozygous: OR = 0.755, 95%CI: 0.602-0.947, P = 0.015; dominant: OR = 0.676, 95%CI: 0.547-0.835, P < 0.001; recessive: OR = 0.738, 95%CI: 0.623-0.873, P < 0.001).
CONCLUSION The present meta-analysis suggests that the IL-8-251A/T polymorphism might be a protective factor for genetic susceptibility to AP.
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Affiliation(s)
- Huan Liu
- Department of Preventive Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Wei Zhang
- Department of Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xiao-Dong Deng
- Department of Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Ying Ma
- Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Yun Liu
- Department of Forensic Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Cortisol Outperforms Novel Cardiovascular, Inflammatory, and Neurohumoral Biomarkers in the Prediction of Outcome in Acute Pancreatitis. Pancreas 2018; 47:55-64. [PMID: 29215538 DOI: 10.1097/mpa.0000000000000962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aims of this study were to assess whether copeptin, pro-atrial natriuretic peptide, proadrenomedullin, and cortisol are associated with disease severity in patients with acute pancreatitis (AP) and to compare their ability in predicting organ failure or death. METHODS From April 2011 to January 2015, 142 patients with AP were included in this prospective single-center study and observed for 4 days. Disease severity was rated by the Atlanta 1992 and 2012 criteria and organ failure by the modified Marshall score. The aforementioned laboratory markers, C-reactive protein, and procalcitonin were measured. RESULTS Patients with moderate to severe AP showed significantly higher plasma concentrations of all biomarkers than did those with mild AP. Overall, 30 organ failures or deaths occurred. All biomarkers except cortisol had only modest discriminatory ability, with areas under the receiver operating characteristic curve (AUCs) between 0.44 and 0.66. Cortisol showed an AUC of 0.78 compared with the Acute Physiology and Chronic Health Evaluation II score with an AUC of 0.75. CONCLUSIONS Cortisol was the best predictor of organ failure or death. All biomarkers were associated with disease severity to a similar degree as C-reactive protein, the criterion-standard marker in AP. Further studies are warranted to define their clinical role.
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Abstract
OBJECTIVE Early risk assessment is important in acute pancreatitis (AP). The primary objective of this study was to compare various scores and biochemical markers done on the day of admission in predicting the outcome. METHODS Demographic, clinical, and laboratory data of patients presenting within 2 weeks of onset were collected. Various scores were calculated and biochemical markers were measured on the day of admission. Optimum cutoffs were identified through receiver operating curve analysis. Multivariate analysis was used to identify predictors of outcome. RESULTS Of 343 patients included, 202 (59%) were male; mean (SD) age was 38.7 (15.5) years. Acute pancreatitis was severe in 170 (49.6%) patients. Twenty-eight percent of the patients developed infected pancreatic necrosis and 18% died. An Acute Physiology and Chronic Health Evaluation (APACHE II) score of at least 7, bedside index for severity of AP (BISAP) of at least 2, systemic inflammatory response syndrome score of at least 3, and C-reactive protein of at least 82 ng/mL predicted severity. Predictors of infected pancreatic necrosis were as follows: PANC 3 score of at least 1, BISAP score of at least 2, and Marshall score of at least 2, whereas C-reactive protein of greater than 98, BISAP score of at least 2, APACHE score of at least 10, and a blood urea nitrogen of at least 17 predicted mortality. CONCLUSIONS Both BISAP and APACHE II are comparable in predicting outcome, but BISAP predicted all 3 outcomes with the same cutoff and hence is a robust scoring system.
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Pan LL, Li J, Shamoon M, Bhatia M, Sun J. Recent Advances on Nutrition in Treatment of Acute Pancreatitis. Front Immunol 2017; 8:762. [PMID: 28713382 PMCID: PMC5491641 DOI: 10.3389/fimmu.2017.00762] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/16/2017] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis (AP) is a common abdominal acute inflammatory disorder and the leading cause of hospital admission for gastrointestinal disorders in many countries. Clinical manifestations of AP vary from self-limiting local inflammation to devastating systemic pathological conditions causing significant morbidity and mortality. To date, despite extensive efforts in translating promising experimental therapeutic targets in clinical trials, disease-specific effective remedy remains obscure, and supportive care has still been the primary treatment for this disease. Emerging evidence, in light of the current state of pathophysiology of AP, has highlighted that strategic initiation of nutrition with appropriate nutrient supplementation are key to limit local inflammation and to prevent or manage AP-associated complications. The current review focuses on recent advances on nutritional interventions including enteral versus parenteral nutrition strategies, and nutritional supplements such as probiotics, glutamine, omega-3 fatty acids, and vitamins in clinical AP, hoping to advance current knowledge and practice related to nutrition and nutritional supplements in clinical management of AP.
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Affiliation(s)
- Li-Long Pan
- School of Medicine, Jiangnan University, Wuxi, China
| | - Jiahong Li
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China
- Nutrition and Immunology Laboratory, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Muhammad Shamoon
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China
- Nutrition and Immunology Laboratory, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Madhav Bhatia
- Inflammation Research Group, Department of Pathology, University of Otago, Christchurch, New Zealand
| | - Jia Sun
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China
- Nutrition and Immunology Laboratory, School of Food Science and Technology, Jiangnan University, Wuxi, China
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NAD + augmentation ameliorates acute pancreatitis through regulation of inflammasome signalling. Sci Rep 2017; 7:3006. [PMID: 28592850 PMCID: PMC5462749 DOI: 10.1038/s41598-017-03418-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 04/27/2017] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis (AP) is a complicated disease without specific drug therapy. The cofactor nicotinamide adenine dinucleotide (NAD+) is an important regulator of cellular metabolism and homeostasis. However, it remains unclear whether modulation of NAD+ levels has an impact on caerulein-induced AP. Therefore, in this study, we investigated the effect of increased cellular NAD+ levels on caerulein-induced AP. We demonstrated for the first time that the activities and expression of SIRT1 were suppressed by reduction of intracellular NAD+ levels and the p53-microRNA-34a pathway in caerulein-induced AP. Moreover, we confirmed that the increase of cellular NAD+ by NQO1 enzymatic action using the substrate β-Lapachone suppressed caerulein-induced AP with down-regulating TLR4-mediated inflammasome signalling, and thereby reducing the inflammatory responses and pancreatic cell death. These results suggest that pharmacological stimulation of NQO1 could be a promising therapeutic strategy to protect against pathological tissue damage in AP.
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Wang W, Xiang HP, Wang HP, Zhu LX, Geng XP. CD4 + CD25 + CD127 high cells as a negative predictor of multiple organ failure in acute pancreatitis. World J Emerg Surg 2017; 12:7. [PMID: 28174597 PMCID: PMC5290669 DOI: 10.1186/s13017-017-0116-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 01/11/2017] [Indexed: 01/07/2023] Open
Abstract
Background It has been suggested that severity of the immune response induced by immune cells is associated with morbidity and mortality from acute pancreatitis. The authors investigated and evaluated the relationship between distinct peripheral lymphocyte subsets at admission and clinical outcome prior to hospital discharge so as to find a predictor to the prognosis of acute pancreatitis in lymphocyte profile. Methods Lymphocyte subsets in admission peripheral venous blood were tested through flow cytometry on 48 patients with acute pancreatitis. Clinical data was recorded as well. The primary observational outcomes were multiple organ failure (MOF) and infection. Results There was a significant difference in natural killer cells between two subgroups sorted by the presence or absence of infection (25.5 ± 4.47 [95% CI 14.4, 36.6] vs 14.8 ± 7.62 [95% CI 12.5,1 7.1] p = 0.021). Patients who developed MOF had lower CD4 + CD25 + CD127high (4.49 ± 1.5 (MOF) [95% CI 3.83, 5.16] vs 6.57 ± 2.65 (non-MOF) [95% CI 5.5, 7.64] p = 0.002) and higher CD127low/high cell counts (1.35 ± 0.66 [95% CI 1.06, 1.65] vs 0.97 ± 0.44 [95% CI 0.79, 1.15] p = 0.02). MOF patients were significantly older (55 ± 14.58 [95% CI 48.49,61.42] vs 46 ± 15.59 [95% CI 39.39,51.99] p = 0.04), and had higher Acute Physiology and Chronic Health Evaluation IIscores (7 ± 3.66 [95% CI 5.5,7.64] vs 4 ± 2.89 [95% CI 2.45,4.78] p = 0.001) and C reactive protein (100.53 ± 94.38 [95% CI 58.69,142.48] vs 50.8 ± 59.2 [95% CI 26.88,74.71] p = 0.04). In a multivariate regression model, only CD4 + CD25 + CD127high cell was a significant predictor of non-MOF. For the detection of non-MOF, CD4 + CD25 + CD127high cell generated a receiver operating characteristic (ROC) curve with an area under the curve of 0.74. Conclusion CD4 + CD25 + CD127high cell at early phase of acute pancreatitis yields good specificity in detecting non-MOF at a suggested cutoff value 6.41%. Patients with fewer natural killer cells may be at risk in developing secondary infection.
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Affiliation(s)
- Wei Wang
- Department of Emergency Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601 Anhui Province People's Republic of China
| | - He-Ping Xiang
- Department of Emergency Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601 Anhui Province People's Republic of China
| | - Hui-Ping Wang
- Hematology department, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601 Anhui Province People's Republic of China
| | - Li-Xin Zhu
- Central lab of the First Affiliated Hospital of Anhui Medical University, Hefei, 230022 Anhui Province People's Republic of China
| | - Xiao-Ping Geng
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601 Anhui Province People's Republic of China
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Shamoon M, Deng Y, Chen YQ, Bhatia M, Sun J. Therapeutic implications of innate immune system in acute pancreatitis. Expert Opin Ther Targets 2015; 20:73-87. [PMID: 26565751 DOI: 10.1517/14728222.2015.1077227] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Acute pancreatitis (AP) is an inflammatory disorder of the pancreas encompassing a cascade of cellular and molecular events. It starts from premature activation of zymogens with the involvement of innate immune system to a potential systemic inflammatory response and multiple organ failure. Leukocytes are the major cell population that participate in the propagation of the disease. Current understanding of the course of AP is still far from complete, limiting treatment options mostly to conservative supportive care. Emerging evidence has pointed to modulation of the immune system for strategic therapeutic development, by mitigating the inflammatory response and severity of AP. In the current review, we have focused on the role of innate immunity in the condition and highlighted therapeutics targeting it for treatment of this challenging disease. AREAS COVERED The current review has aimed to elaborate in-depth understanding of specific roles of innate immune cells, derived mediators and inflammatory pathways that are involved in AP. Summarizing the recent therapeutics and approaches applied experimentally that target immune responses to attenuate AP. EXPERT OPINION The current state of knowledge on AP, limitations of presently available therapeutic approaches and the promise of therapeutic implications of innate immune system in AP are discussed.
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Affiliation(s)
- Muhammad Shamoon
- a 1 Jiangnan University, School of Food Science and Technology, The Synergetic Innovation Center of Food Safety and Nutrition, State Key Laboratory of Food Science and Technology , Wuxi, Jiangsu, China
| | - Yuanyuan Deng
- a 1 Jiangnan University, School of Food Science and Technology, The Synergetic Innovation Center of Food Safety and Nutrition, State Key Laboratory of Food Science and Technology , Wuxi, Jiangsu, China
| | - Yong Q Chen
- a 1 Jiangnan University, School of Food Science and Technology, The Synergetic Innovation Center of Food Safety and Nutrition, State Key Laboratory of Food Science and Technology , Wuxi, Jiangsu, China
| | - Madhav Bhatia
- b 2 University of Otago, Inflammation Research Group, Department of Pathology , Christchurch, 2 Riccarton Avenue, P.O. Box 4345, Christchurch 8140, New Zealand
| | - Jia Sun
- a 1 Jiangnan University, School of Food Science and Technology, The Synergetic Innovation Center of Food Safety and Nutrition, State Key Laboratory of Food Science and Technology , Wuxi, Jiangsu, China
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Shen YZ, Guo X, Bai Y. Risk factors for early infection in patients with severe acute pancreatitis complicated with diabetes mellitus. Shijie Huaren Xiaohua Zazhi 2015; 23:5064-5069. [DOI: 10.11569/wcjd.v23.i31.5064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the risk factors for early complications in patients with severe acute pancreatitis (SAP) complicated with diabetes mellitus (DM).
METHODS: Eighty-six patients with SAP complicated with DM treated at our hospital from June 2009 to January 2014 were retrospectively analyzed. According to the presence of infection episodes or not during early symptomatic treatment, the patients were divided into either an infection group (38 cases) or a non-infection group (48 cases). The risk factors for early infection were identified by Logistic regression analysis.
RESULTS: Univariate analysis showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, biliary pathogenic factors, fasting time, hyoxemia, high serum creatinine, procalcitonin (PCT), C-reactive protein (CRP), mechanical ventilation and the use of antibiotics were statistically associated with early infection. Logistic multivariate regression analysis showed that APACHE Ⅱ score > 11 (OR = 9.793), hyoxemia (OR = 5.202), fasting time > 7 d (OR = 1.476), increased PCT (OR = 6.861) and the use of antibiotics (OR = 4.125) were independent risk factors for early infection in patients with SAP combined with DM.
CONCLUSION: The development of early infection in SAP combined with DM is closely related with many risk factors, which should be aimed by doctors at early stage to reduce the risk of infection and mortality.
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Almeida N, Fernandes A, Casela A. Predictors of Severity and In-Hospital Mortality for Acute Pancreatitis: Is There Any Role for C-Reactive Protein Determination in the First 24 Hours? GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:187-189. [PMID: 28868406 PMCID: PMC5579989 DOI: 10.1016/j.jpge.2015.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Nuno Almeida
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Alexandra Fernandes
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adriano Casela
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Staubli SM, Oertli D, Nebiker CA. Laboratory markers predicting severity of acute pancreatitis. Crit Rev Clin Lab Sci 2015; 52:273-83. [PMID: 26173077 DOI: 10.3109/10408363.2015.1051659] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute pancreatitis (AP) is an inflammatory disease of highly variable severity, ranging from mild cases with low mortality to severe cases with high mortality. Numerous biomarkers have been studied as potential early predictors of the severity of this disease so that treatment can be optimally tailored to prevent complications. We aim to present and discuss the most relevant biomarkers for early severity assessment in AP that have been studied to date. We review the current literature on biomarkers that have been used to predict the severity in AP. C-reactive protein (CRP) is still considered to be the gold standard, with a cut-off value of 150 mg/ml 48 h after disease onset. Other markers, including procalcitonin (PCT) and interleukin 6 (IL-6) have been implemented in some hospitals, but are not used on a routine basis. Most other markers, including acute phase proteins (LBP, SAA, PTX3), cytokines (Il-8, TNF-a, MIF), activation peptides of pancreatic proteases (TAP, CAPAP, PLAP), antiproteases (AAT, a2M), adhesion molecules (ICAM-1, selectins, E-cadherin) and leukocyte-derived enzymes (PA2, PMN-E) have shown some promising results but have not been routinely implemented. Furthermore, new and interesting biomarkers (Copeptin, TRX-1, Ang-2, E-2) have shown good results, but more research is needed to determine if they could play a role in the future. Various reasons why new markers for disease severity have not been adopted in daily routine include low accuracy, cumbersome laboratory techniques and high cost. Despite these difficulties, research is still very active in finding new markers to predict the severity of AP.
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Affiliation(s)
| | - Daniel Oertli
- a Department of General Surgery , University Hospital Basel , Basel , Switzerland
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Sapra R, Mehrotra S, Nundy S. Artificial Neural Networks: Prediction of mortality/survival in gastroenterology. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.cmrp.2015.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tan YHA, Rafi S, Tyebally Fang M, Hwang S, Lim EW, Ngu J, Tan SM. Validation of the modified Ranson versus Glasgow score for pancreatitis in a Singaporean population. ANZ J Surg 2015; 87:700-703. [PMID: 25924928 DOI: 10.1111/ans.13139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The characteristics of patients with acute pancreatitis in multi-ethnic Singapore differ from that of the populations used in formulating the modified Ranson and Glasgow scores. The use of these scoring systems has not previously been validated in the Singaporean setting. This study aims to validate and compare the prognostic use of the modified Ranson and Glasgow scores, and to determine the superiority of one score over the other in predicting the outcome for acute pancreatitis in the Singaporean population. METHODS This is a 3-year retrospective study of patients diagnosed with acute pancreatitis at our centre. Patients with chronic pancreatitis, acute on chronic pancreatitis, iatrogenic pancreatitis, pancreatic cancer as well as those with incomplete Ranson or Glasgow scores were excluded from the study. Case notes and computer records were reviewed for local complications of pancreatitis and organ failure. Receiver operator characteristic (ROC) curves of the Ranson and Glasgow scores were plotted for the prediction of severity and mortality. RESULTS Between January 2010 and December 2012, 230 cases were diagnosed with acute pancreatitis. A majority of the patients had mild pancreatitis (n = 194, 84.3%), and the overall 30-day mortality rate was 3.5% (n = 8). ROC of the Ranson and Glasgow scoring systems for mortality showed an area under curve (AUC) of 0.854 (P = 0.001) and 0.776 (P = 0.008), respectively. For severity, the AUC for the modified Ranson and Glasgow score was calculated to be 0.694 and 0.668, respectively. CONCLUSIONS The ROC curves of Ranson and Glasgow scores for mortality are comparable with that published in earlier studies. In a Singaporean population, the Ranson score is more accurate in the prediction of mortality. However, both scoring systems are poor predictors for severity of acute pancreatitis.
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Affiliation(s)
| | - Shumaila Rafi
- Department of Surgery, Changi General Hospital, Singapore
| | | | - Stephen Hwang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ee Wen Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Ngu
- Department of Surgery, Changi General Hospital, Singapore
| | - Su-Ming Tan
- Department of Surgery, Changi General Hospital, Singapore
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Abstract
OBJECTIVES Toll-like receptors (TLRs) are damage-associated molecular patterns receptors, which are essential in the activation of the inflammasome cascade, required for the initiation of inflammation. We hypothesized that changes in the function of these receptors caused by genetic polymorphisms in their encoding genes could determine acute pancreatitis (AP) incidence or severity. METHODS Two hundred sixty-nine patients and 269 controls were included. Acute pancreatitis diagnosis criteria were abdominal pain, increased serum amylase levels, and positive findings on abdominal imaging. The patients were observed until discharge. Blood samples were obtained, determining the following TLRs: TLR1 rs5743611, TLR2 rs5743704, TLR3 rs3775291, TLR3 rs5743305, TLR4 rs4986790, TLR4 rs4986791, TLR5 rs5744174, TLR6 rs5743795, TLR7 rs2302267, TLR9 rs352140, and TLR10 rs4129009. RESULTS No TLR polymorphism was related to AP incidence. Regarding severity, CC genotype patients in TLR3 rs3775291 had an increased risk for severe pancreatitis (CC odds ratio [OR], 2.426; P = 0.015). In addition, TLR6 rs5743795 GG genotype patients had a lower risk for severe AP (GG OR, 0.909; P < 0.05). Intensive care unit admission was related to TLR5 rs5744174 homozygote TT carriers (TT OR, 3.367; P = 0.036). CONCLUSIONS Our article points to genetic polymorphisms in TLR3 and TLR6 as having a plausible role in the occurrence of severe AP.
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Abstract
OBJECTIVES We aimed to evaluate the anti-inflammatory and inhibitory effects of Lithospermum erythrorhizon (LE) on cerulein-induced acute pancreatitis (AP) in a mouse model. METHODS Acute pancreatitis was induced via intraperitoneal injection of cerulein (50 μg/kg) every hour for 6 times. In the LE, water extract (100, 250, or 500 mg/kg) was administered intraperitoneally 1 hour before the first injection of cerulein. Six hours after AP, blood, the pancreas, and the lung were harvested for further examination. In addition, pancreatic acinar cells were isolated using a collagenase method, and then, we investigated the acinar cell viability and cytokine productions. RESULTS Treatment with LE reduced pancreatic damage and AP-associated lung injury and attenuated the severity of AP, as evidenced by the reduction in neutrophil infiltration, serum amylase and lipase levels, trypsin activity, and proinflammatory cytokine expression. In addition, treatment with LE inhibited high mobility group box 1 expression in the pancreas during AP. In accordance with in vivo data, LE inhibited the cerulein-induced acinar cell death, cytokine productions, and high-mobility group box 1 expression. Furthermore, LE also inhibited the activation of p38 mitogen-activated protein kinases. CONCLUSIONS These results suggest that LE plays a protective role during the development of AP by inhibiting the activation of p38.
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Shen Y, Deng X, Xu N, Li Y, Miao B, Cui N. Relationship between the degree of severe acute pancreatitis and patient immunity. Surg Today 2014; 45:1009-17. [PMID: 25410475 DOI: 10.1007/s00595-014-1083-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/12/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the relationship between the APACHE II score and the immunity of patients with severe acute pancreatitis. METHODS Clinical data were collected from 88 patients with acute pancreatitis, divided into four groups according to the severity of the disease. C-reactive protein (CRP), tumor necrosis factor-α, interleukin-6, interleukin-10, interleukin-4 and endotoxin (ET) in serum were measured on admission and then on days 3, 5, and 7. RESULTS The incidence of local complications and multiple organ dysfunction syndrome increased with a higher APACHE II score. The CRP levels were increased significantly on day 3 in all four groups, but remained high only in the extremely severe group. In the mild and moderate groups, the pro-/anti-inflammatory cytokines peaked on day 3 and then decreased slowly. In the severe and extremely severe groups, the proinflammatory cytokines levels peaked on days 3 and 5, and then decreased rapidly. The antiinflammatory cytokines increased progressively on days 3, 5 and 7. The ET levels peaked significantly and then decreased slowly in the mild, moderate and severe groups, but remained high in the extremely severe group. CONCLUSIONS An APACHE II score of 16 or higher is predictive of more local and systemic complications, excessive immune response, and premature immunosuppression.
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Affiliation(s)
- Yinfeng Shen
- Department of Surgery, Hubei Hospital of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, People's Republic of China
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Vasseur P, Devaure I, Sellier J, Delwail A, Chagneau-Derrode C, Charier F, Tougeron D, Tasu JP, Rabeony H, Lecron JC, Silvain C. High plasma levels of the pro-inflammatory cytokine IL-22 and the anti-inflammatory cytokines IL-10 and IL-1ra in acute pancreatitis. Pancreatology 2014; 14:465-9. [PMID: 25240697 DOI: 10.1016/j.pan.2014.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/25/2014] [Accepted: 08/15/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Pancreatic acinar cells are major targets of IL-22. Our aim is to study early plasma levels of IL-22, of pro- and anti-inflammatory cytokines in acute pancreatitis, and their association with severity or necrosis infection. METHODS Consecutive patients admitted to the Department of Hepato-Gastroenterology at Poitiers University of Medicine Hospital (France) with a diagnosis of AP were prospectively enrolled. Plasma concentrations of IL-22, IL-6, IL-8, IL-1 α, IL-1β, TNF- α, IFN-γ, IL-17A, IL-10, IL-1ra and IL-4 were assessed by multiple immunoassay at the admission time. A thoracoabdominal contrast-enhanced CT scan was performed at day 2. RESULTS Sixty-two patients were included; 13 patients (21%) had a severe acute pancreatitis, 5 patients (8%) developed necrosis infection and 29 patients (47%) had pleural effusion. Plasma levels of IL-22 were high in AP (135 ± 31 vs 4.2 ± 1.8 pg/ml for controls, p < 0.05), but did not correlate with the severity of the disease, whereas IL-6, IL-10 and IL-1ra where enhanced in patients with severe acute pancreatitis and with pleural effusion. Patients who further developed necrosis infection had higher levels of IL-1ra at admission (p = 0.0004). CONCLUSION In acute pancreatitis, high plasma levels of IL-22 are observed, regardless the severity of the disease. In contrast, severe forms were associated with increased levels of IL-6, IL-10 and IL-1ra. The beneficial or deleterious role of IL-22 in AP remains to be further studied.
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Affiliation(s)
- Philippe Vasseur
- Department of Hepato-Gastroenterology, Poitiers University Hospital, 86021 Poitiers, France; Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Pôle Biologie Santé, 86022 Poitiers, France.
| | - Iris Devaure
- Department of Hepato-Gastroenterology, Poitiers University Hospital, 86021 Poitiers, France
| | - Jacques Sellier
- Department of Radiology, Poitiers University Hospital, 86000 Poitiers, France
| | - Adriana Delwail
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Pôle Biologie Santé, 86022 Poitiers, France
| | | | - Florian Charier
- Department of Hepato-Gastroenterology, Poitiers University Hospital, 86021 Poitiers, France
| | - David Tougeron
- Department of Hepato-Gastroenterology, Poitiers University Hospital, 86021 Poitiers, France; Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Pôle Biologie Santé, 86022 Poitiers, France
| | - Jean-Pierre Tasu
- Department of Radiology, Poitiers University Hospital, 86000 Poitiers, France
| | - Hanitriniaina Rabeony
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Pôle Biologie Santé, 86022 Poitiers, France
| | - Jean-Claude Lecron
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Pôle Biologie Santé, 86022 Poitiers, France; Department of Immunology/Inflammation, Poitiers University Hospital, 86021 Poitiers, France
| | - Christine Silvain
- Department of Hepato-Gastroenterology, Poitiers University Hospital, 86021 Poitiers, France; Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Pôle Biologie Santé, 86022 Poitiers, France
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Ke L, Tong ZH, Li WQ, Wu C, Li N, Windsor JA, Li JS, Petrov MS. Predictors of critical acute pancreatitis: a prospective cohort study. Medicine (Baltimore) 2014; 93:e108. [PMID: 25380082 PMCID: PMC4616279 DOI: 10.1097/md.0000000000000108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Critical acute pancreatitis (CAP) has recently emerged as the most ominous severity category of acute pancreatitis (AP). As such there have been no studies specifically designed to evaluate predictors of CAP. In this study, we aimed to evaluate the accuracy of 4 parameters (Acute Physiology and Chronic Health Evaluation [APACHE] II score, C-reactive protein [CRP], D-dimer, and intra-abdominal pressure [IAP]) for predicting CAP early after hospital admission. During the study period, data on patients with AP were prospectively collected and D-dimer, CRP, and IAP levels were measured using standard methods at admission whereas the APACHE II score was calculated within 24 hours of hospital admission. The receiver-operating characteristic (ROC) curve analysis was applied and the likelihood ratios were calculated to evaluate the predictive accuracy. A total of 173 consecutive patients were included in the analysis and 47 (27%) of them developed CAP. The overall hospital mortality was 11% (19 of 173). APACHE II score ≥11 and IAP ≥13 mm Hg showed significantly better overall predictive accuracy than D-dimer and CRP (area under the ROC curve-0.94 and 0.92 vs. 0.815 and 0.667, correspondingly). The positive likelihood ratio of APACHE II score is excellent (9.9) but of IAP is moderate (4.2). The latter can be improved by adding CRP (5.8). In conclusion, of the parameters studied, APACHE II score and IAP are the best available predictors of CAP within 24 hours of hospital admission. Given that APACHE II score is rather cumbersome, the combination of IAP and CRP appears to be the most practical way to predict critical course of AP early after hospital admission.
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Affiliation(s)
- Lu Ke
- Department of General Surgery (LK, ZT, WL, CW, NL, JL), Jinling Hospital, Nanjing University School of Medicine, Nanjing, China; and Department of Surgery (JAW, MSP), University of Auckland, Auckland, New Zealand
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Phillip V, Steiner JM, Algül H. Early phase of acute pancreatitis: Assessment and management. World J Gastrointest Pathophysiol 2014; 5:158-168. [PMID: 25133018 PMCID: PMC4133515 DOI: 10.4291/wjgp.v5.i3.158] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/25/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis.
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Biological markers of severity in acute pancreatitis. Open Med (Wars) 2014. [DOI: 10.2478/s11536-014-0503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
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Acute necrotizing pancreatitis: laboratory, clinical, and imaging findings as predictors of patient outcome. AJR Am J Roentgenol 2014; 202:1215-31. [PMID: 24848818 DOI: 10.2214/ajr.13.10936] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In patients with acute necrotizing pancreatitis, we analyzed whether laboratory and clinical findings determined in the early phase of disease and morphologic features on contrast-enhanced CT (CECT) at the beginning of the late phase of disease are helpful in predicting patient outcome and whether CECT findings provide additional information in establishing prognosis compared with the laboratory and clinical findings. MATERIALS AND METHODS A retrospective analysis of 99 patients with acute necrotizing pancreatitis was performed. Four laboratory variables (albumin, calcium, C-reactive protein, WBC count) and three clinical variables (Acute Physiology, Age, Chronic Health Evaluation [APACHE] II score; Simplified Acute Physiology Score [SAPS] II; persistent organ failure) were assessed. Five morphologic features on CECT including Balthazar grade and CT severity index were reviewed. The endpoints of patient outcome were peripancreatic or pancreatic infection, need for intervention, duration of organ failure, ICU and hospital stays, and death. Based on receiver operating characteristic curve analysis for infection, high-and low-risk groups for each prognostic variable were calculated and univariable and multivariable Cox regression analyses were carried out. RESULTS In our study population of 99 patients (63 men, 36 women; median age, 52 years; age range, 18-84 years), 25 patients (25%) developed infection, 42 patients (42%) experienced organ failure, and 12 patients (12%) died. Regarding the laboratory and clinical variables, albumin level, APACHE II score, and particularly persistent organ failure were the strongest independent predictors of patient outcome. Regarding the imaging variables, Balthazar grade and a morphologic feature that takes the distribution of intrapancreatic necrosis into account were the strongest independent predictors. In the multivariable analysis of all studied variables, imaging variables were independent and strong predictors of patient outcome and provided additional information in establishing prognosis compared with clinical and laboratory findings. CONCLUSION In patients with suspected or proven acute necrotizing pancreatitis, performing CECT at the beginning of the late phase of disease is recommended to identify patients at increased risk for adverse outcomes.
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Identification of serum microRNAs as diagnostic and prognostic biomarkers for acute pancreatitis. Pancreatology 2014; 14:159-66. [PMID: 24854610 DOI: 10.1016/j.pan.2014.03.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/02/2014] [Accepted: 03/17/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES To identify serum microRNA (miRNA) as diagnostic and prognostic biomarkers for acute pancreatitis (AP). MATERIALS AND METHODS Sera microRNA expression was profiled from 12 AP patients with varying disease severity and three healthy controls. Differentially expressed miRNAs were validated in a larger cohort of patients and controls. The diagnostic and prognostic potentials of differentially expressed miRNAs were evaluated using receiver operating characteristic (ROC) curve analysis and compared to that of classic prognostic markers for AP. RESULTS miRNA microarray analyses identified 205 differentially expressed miRNAs between sera from AP patients and that from controls. Nine miRNAs were differentially expressed between severe and mild AP patients. Further validation confirmed the down-regulation of miR-92b, miR-10a, and miR-7 in AP patients, and ROC analysis revealed that these miRNAs can differentiate AP from health cases. Furthermore, the serum miR-551b-5p level was significantly higher in patients with disease complications or a low plasma calcium level. ROC analysis showed that the serum miR-551b-5p level can distinguish between severe and mild AP. CONCLUSION The expressions of miR-92b, miR-10a, and miR-7 in AP might be used for the early diagnosis of AP and miR-551b-5p may be used for predicting AP severity.
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Pelaez-Luna M. [Is calcium the solution to the difficult task of predicting severity in acute pancreatitis?]. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2014; 79:1-2. [PMID: 24656511 DOI: 10.1016/j.rgmx.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/10/2014] [Indexed: 06/03/2023]
Affiliation(s)
- M Pelaez-Luna
- Profesor Asociado de Medicina, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México DF, México; Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México DF, México.
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